The American Diabetes Association (ADA) emphasizes the use of GLP-1 and GIP/GLP-1 receptor agonists in patients with type 2 diabetes who would benefit from weight and glycemic lowering benefits. As the ADA guidelines have evolved, GLP-1 RA or GIP/GLP-1 RAs have been suggested earlier in treatment. With an update to the 2024 type 2 diabetes diagnostic criteria, ProAct will be updating its clinical criteria for clients with the standard prior authorization offering in place for patients new to therapy:
Submission of two abnormal screening test results (A1C ≥6.5%; fasting plasma glucose [FPG] ≥126 mg/dL, 2-hour plasma glucose [2hPG] ≥200 mg/dL, per the 2024 T2D diagnostic criteria; and
The above will be added to the criteria requiring a trial and failure to a metformin-containing drug therapy, unless patients with diabetes have documentation of comorbidities, which require treatment with a GLP-1 RA or a GIP/GLP-1 RA or a contraindication.
Documentation of random plasma glucose ≥200 mg/dL in an individual with classic symptoms of hyperglycemia or hyperglycemic crisis, measured either at the same time or at two different time points.
https://diabetesjournals.org/care/article/47/Supplement_1/S20/153954/2-Diagnosis-and-Classification-of-Diabetes
